Effect of inter-aural temporal envelope differences on inter-aural time difference thresholds for amplitude modulated noise

ABSTRACT Purpose The inter-aural time difference (ITD) and inter-aural level difference (ILD) are important acoustic cues for horizontal localization and spatial release from masking. These cues are encoded based on inter-aural comparisons of tonotopically matched binaural inputs. Therefore, binaural coherence or the interaural spectro-temporal similarity is a pre-requisite for encoding ITD and ILD. The modulation depth of envelope is an important envelope characteristic that helps in encoding the envelope-ITD. However, inter-aural difference in modulation depth can result in reduced binaural coherence and poor representation of binaural cues as in the case with reverberation, noise and compression in cochlear implants and hearing aids. This study investigated the effect of inter-aural modulation depth difference on the ITD thresholds for an amplitude-modulated noise in normal hearing young adults. Methods An amplitude modulated high pass filtered noise with varying modulation depth differences was presented sequentially through headphones. In one ear, the modulation depth was retained at 90% and in the other ear it varied from 90% to 50%. The ITD thresholds for modulation frequencies of 8 Hz and 16 Hz were estimated as a function of the inter-aural modulation depth difference. Results The Friedman test findings revealed a statistically significant increase in the ITD threshold with an increase in the inter-aural modulation depth difference for 8 Hz and 16 Hz. Conclusion The results indicate that the inter-aural differences in the modulation depth negatively impact ITD perception for an amplitude-modulated high pass filtered noise.

Resenha do livro "Educação Física Menor" / Review of the book "Minor Physical Education" / Reseña del libro "Educación Física Menor"

O livro "Educação Física Menor" problematiza e propõe alternativas diante do chamado currículo cultural ou pós-crítico de Educação Física. Faz isso, a partir de dois gestos: problematizando algumas acepções culturalistas e almejando a singularização ou a minoração das perspectivas "maiores" do componente, a partir de uma conceitualização das filosofias de pensadores como Foucault, Deleuze e Guattari.

The book "Minor Physical Education" problematizes and proposes alternatives to the so-called cultural or post-critical curriculum of Physical Education. It does this from two gestures: problematizing some culturalist acceptations and aiming at the singularization or the minimization of the "major" perspectives of the component, from a conceptualization of the philosophies of thinkers such as Foucault, Deleuze and Guattari.

El libro "Educación Física Menor" problematiza y propone alternativas al llamado currículo cultural o postcrítico de la Educación Física. Lo hace a través de dos gestos: problematizando algunos conceptos culturalistas y apuntando a singularizar o disminuir las perspectivas "mayores" del componente, a partir de una conceptualización de las filosofías de pensadores como Foucault, Deleuze y Guattari.

Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease / Diferencia arteriovenosa de CO2 como biomarcador de desenlace en niños operados de cardiopatías congénitas

Abstract Background: In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO2), arteriovenous oxygen difference (DavO2), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO2 difference (ΔCO2) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO2 and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO2, SvO2, and lactate. Methods: We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021. Results: Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO2 ≥ 6 mmHg. Patients with ΔCO2 ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO2 > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die. Conclusion: ΔCO2 is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.

Resumen Introducción: En la cirugía cardiaca de malformaciones congénitas, el síndrome de bajo gasto cardiaco (SBGC) es una de las principales causas de morbilidad en el postoperatorio inmediato. La caída del gasto cardiaco aumenta el consumo de oxígeno en los tejidos. Varios biomarcadores, como la saturación venosa de oxígeno (SvO2), la diferencia arteriovenosa de oxígeno (DavO2) y el lactato han sido utilizados como indicadores hipoperfusión tisular en presencia de SBGC. Recientemente, la diferencia arteriovenosa de CO2 (ΔCO2) se ha propuesto como otro biomarcador de isquemia tisular que podría utilizarse como predictor de muerte en pacientes en edad neonatal. El objetivo de este estudio fue analizar la relación entre la ΔCO2 y la evolución postoperatoria de pacientes pediátricos operados de cardiopatías congénitas y correlacionarlo con la DavO2, SvO2 y lactato. Métodos: Se realizó un estudio longitudinal en pacientes de 0 a 18 años operados de corazón con empleo de bomba de circulación extracorpórea en el Instituto Nacional de Pediatría. Resultados: Se incluyeron 82 pacientes; la mediana de edad fue de 17 meses. El 59% presentó un ΔCO2 > 6 mmHg. Los pacientes con un ΔCO2 > 6 mmHg mostraron un puntaje de inotrópicos > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048) y lactato > 2 mmol/L (p = 0.027), así como mayor estancia hospitalaria (p = 0.043). Los pacientes con ΔCO2 > 6 mmHg y un puntaje de inotrópicos ≥ 10 presentaron una probabilidad de muerte 12.6 veces mayor. Conclusiones: El ΔCO2 en el periodo postoperatorio de una cirugía cardiaca congénita es un buen marcador de hipoperfusión tisular y de desenlace.

3D Foot Anthropometric Measurements Under Two Weight- Bearing Conditions for Ergonomic Design of Foot-Related Products / Mediciones Antropométricas del Pie en 3D Bajo Dos Condiciones de Soporte de Peso para el Diseño Ergonómico de Productos Relacionados con los Pies

SUMMARY: This study collected 3D models of the left and right feet from 317 Chinese youth (155 females and 162 males) under half weight-bearing and no weight-bearing conditions. Thirteen dimensions and one angle were taken for each sample. By measuring 13 foot dimensions and 1 angle, this study comprehensively investigated the differences in foot shape between genders and the bilateral differences, as well as the foot shape differences under different conditions. The results showed that regardless of the condition, male foot dimensions were significantly larger than those of females. However, female foot shape was not simply a scaled-down version of male foot shape. On the contrary, the average angle of female feet was greater than that of males under both conditions, indicating a higher prevalence of hallux valgus in females. Both males and females exhibited significant correlation in foot dimensions between the left and right feet, with minimal differences. Under the half weight-bearing condition, the average foot length, width, and circumference were significantly larger than the corresponding measurements under the no weight-bearing condition, while the average height and angle were significantly smaller. Therefore, when designing footwear and foot-related medical rehabilitation aids, it is important to consider foot shape and dimensions under different conditions as a reference. The results of this study provide manufacturers of foot- related products with more detailed data support and are of significant value to the field of medical foot morphology research.

Este estudio recolectó modelos 3D de los pies izquierdo y derecho de 317 jóvenes chinos (155 mujeres y 162 hombres) en condiciones de carga media de peso y sin carga de peso. Para cada muestra se tomaron trece dimensiones y un ángulo. Al medir 13 dimensiones del pie y 1 ángulo, se investigó exhaustivamente las diferencias en la forma del pie entre ambos sexos y sus diferencias bilaterales, así como las diferencias en la forma del pie en diferentes condiciones. Los resultados mostraron que, independientemente de la condición, las dimensiones del pie de los hombres, estos eran significativamente más grandes que los de las mujeres. Sin embargo, la forma del pie femenino no era simplemente una versión reducida de la forma del pie masculino. Por el contrario, el ángulo promedio de los pies de las mujeres fue mayor que el de los hombres en ambas condiciones, lo que indica una mayor prevalencia de hallux valgus en las mujeres. Tanto hombres como mujeres exhibieron una correlación significativa en las dimensiones del pie, entre el pie izquierdo y el derecho, con diferencias mínimas. Bajo la condición de medio soporte de peso, la longitud, el ancho y la circunferencia promedio del pie fueron significativamente mayores que las medidas correspondientes bajo la condición sin soporte de peso, mientras que la altura y el ángulo promedio fueron significativamente más pequeños. Por lo tanto, al diseñar calzado y dispositivos médicos de rehabilitación relacionados con los pies, es importante tener en consideración la forma y las dimensiones del pie en diferentes condiciones como referencia. Los resultados de este estudio, brindan a los fabricantes de productos relacionados con los pies un soporte de datos más detallado y son de gran valor para el campo de la investigación médica de la morfología del pie.

Transferências intergovernamentais são capturadas pelos servidores municipais? Os determinantes da diferença salarial entre o setor público e o setor privado / ¿Las transferencias intergubernamentales son captadas por servidores municipales? Los determinantes de la brecha salarial entre los sectores público y privado / Do local civil servants capture intergovernmental transfers? The different wage determinants between the public and private sector

Resumo Esta pesquisa tem por objetivo investigar o efeito das transferências intergovernamentais na diferença salarial entre os servidores municipais e os funcionários do setor privado. A amostra foi formada por 5.449 municípios durante o período de 2000 a 2016, agrupados em 5.344 áreas mínimas comparáveis. Os procedimentos metodológicos quantitativos foram desenvolvidos em duas etapas. Na primeira, mediu-se a diferença salarial mediana entre os servidores municipais e os funcionários do setor privado por meio da regressão quantílica incondicional. Na segunda, a análise dos determinantes da diferença salarial foi realizada por meio de regressão múltipla com dados em painel, efeitos fixos e estimações adicionais com erros robustos a cluster, correlação temporal e correlação espacial. Os resultados indicaram que o aumento de 1% das transferências intergovernamentais per capita resulta em aumento de 0,067% na diferença salarial nos municípios brasileiros entre os servidores municipais e os funcionários do setor privado. Além disso, a elevação de 1% no Produto Interno Bruto (PIB) per capita resulta numa redução de 0,036% da diferença salarial. Por último, a pesquisa observou que o tamanho populacional aumenta enquanto a competição eleitoral reduz a diferença salarial nos municípios brasileiros.

Resumen Esta investigación tuvo como objetivo investigar el efecto de las transferencias intergubernamentales en la diferencia salarial entre los servidores municipales y los empleados del sector privado. La muestra estuvo conformada por 5.449 municipios durante el período 2000 a 2016, agrupados en 5.344 áreas mínimas comparables. Los procedimientos metodológicos cuantitativos se desarrollaron en dos etapas. En la primera, la mediana de la diferencia salarial entre los empleados municipales y los del sector privado se midió utilizando la regresión por cuantiles incondicionales. En la segunda etapa, el análisis de los determinantes de la brecha salarial se realizó mediante regresión múltiple con datos de panel, efectos fijos y estimaciones adicionales con errores robustos por clúster, correlación temporal y correlación espacial. Los resultados indicaron que un aumento del 1% en las transferencias intergubernamentales per cápita resulta en un aumento del 0,067% en la brecha salarial en los municipios brasileños entre los servidores municipales y los empleados del sector privado. Además, identificó que un aumento de 1% en el PIB per cápita se traduce en una reducción de 0,036% en la brecha salarial. Finalmente, la investigación observó que el tamaño de la población aumenta mientras la competencia electoral reduce la brecha salarial en los municipios brasileños.

Abstract This article examines the intergovernmental transfer effects on wage differences between local civil servants and private sector employees. The sample was composed of 5,449 Brazilian municipalities, working with data from 2000 to 2016 clustered in 5,344 minimum comparable areas (MCA). The methodological procedures were quantitative and developed in two steps. The first step was to assess the median wage difference between local civil servants and private sector employees through unconditional quantile regression. The second was the analysis of different wage determinants through multiple regression with panel data, fixed effects, and additional estimations such as cluster-robust standard errors, temporal correlation, and spatial correlation. The results demonstrated that when per capita intergovernmental transfers increase by 1%, the wage difference between local civil servants and private sector employees increases by 0.067%. Besides that, when per capita GDP increases by 1%, the wage difference decreases by 0.036%. Furthermore, the paper observed that populational size increases and electoral competition decreases wage differences between the public and private sectors in Brazilian municipalities.

A Morphometric Study of Head in the Population of Young Chinese Adults / Estudio Morfométrico de la Cabeza en la Población de Adultos Jóvenes Chinos

SUMMARY: Due to the complexity of head shape, limited 1D or 2D head anthropometry fail to fully capture its shape characteristics. Currently, there is limited research on clustering analysis of head shape from a shape difference perspective, especially for the head shape of Chinese people. Head shape is influenced by factors such as race, sex, and age, making it imperative to create a head shape database for Chinese individuals. In this study, three-dimensional head data of 339 Chinese young adult were collected, and the head shapes were clustered into 7 clusters using an improved k-medoids algorithm. The differences between clusters and the average head shape were further analyzed. It can be foreseen that the head shape database for Chinese young adult constructed in this study has important reference value for the ergonomic design of head-related products and head morphology research, among other fields.

Debido a la complejidad de la forma de la cabeza, la antropometría limitada de ésta, en 1D o 2D, no logra capturar completamente sus características de forma. Actualmente, existen estudios limitados sobre el análisis de agrupamiento de la forma de la cabeza, desde una perspectiva de diferencia de forma, especialmente en el caso de la población china. La forma de la cabeza está influenciada por factores como la raza, el sexo y la edad, por lo que resulta imperativo crear una base de datos sobre la forma de la cabeza de los individuos chinos. En este estudio, se recopilaron datos tridimensionales de la cabeza de 339 adultos jóvenes chinos, y las formas de la cabeza se agruparon en 7 grupos utilizando un algoritmo k-medoids mejorado. Las diferencias entre los grupos y la forma promedio de la cabeza se analizaron a profundidad. Se puede prever que la base de datos sobre la forma de la cabeza de adultos jóvenes chinos construida en este estudio, tiene un valor de referencia importante para el diseño ergonómico de productos relacionados con la morfología de la cabeza, entre otros campos.

Gender Disparities of Youths in Trust on Health Management System during Post-COVID-19 in Bangladesh / Disparidades de gênero de jovens na confiança em sistemas de gestão de saúde durante o período pós-COVID-19 em Bangladesh

Objective: The purpose of this paper is to find out the gender-based disparities in trust in the public health measures taken in Bangladesh during the post-COVID-19 pandemic. Methods: A cross-sectional study design and quantitative research approach were used to collect primary data. A total of 742 students from different socioeconomic backgrounds participated in the survey randomly by filling up a structured questionnaire from 15 June 2022 to 10 July 2022. The Wilks' λ statistic, MANOVA, and Regression analysis were performed in this study to find out the gender-based differences in trust in the public health measures taken in Bangladesh during the post-COVID-19 pandemic. Results: In a multivariate test, the p-value is 0.018 (p<0.05), which implies a significant difference between the trust of males and females among youths about public health measures during the post-COVID-19 pandemic in Bangladesh. This study provides that overall infrastructure, responsiveness, and attachments have a significant correlation with youth trust as all the p-values < 0.001. Conclusions: Health infrastructure and youths' attachment to the various networks and institutions have more impact on determining the level of trust in government health measures during the post-pandemic than the way of government responsiveness; policymakers and advocates will get significant insight from the findings of the study during post-COVID-19. Without gender-sensitive health policy measures, gaining citizens' trust in the government will be difficult.

Objetivo: descobrir as disparidades de confiança baseadas em gênero nas medidas de saúde pública tomadas em Bangladesh, durante a pandemia pós-COVID-19. Métodos: um desenho de estudo transversal e abordagem de pesquisa quantitativa foram usados para coletar dados primários. Um total de 742 estudantes de diferentes origens socioeconômicas participaram da pesquisa aleatoriamente, preenchendo um questionário estruturado de 15 de junho de 2022 a 10 de julho de 2022. A estatística λ de Wilks, MANOVA e a análise de regressão foram realizadas neste estudo para descobrir o sexo - diferenças baseadas na confiança nas medidas de saúde pública tomadas em Bangladesh, durante a pandemia pós-COVID-19. Resultados: em um teste multivariado, o p-valor é 0,018 (p<0.05), o que implica uma diferença significativa entre a confiança de homens e mulheres entre jovens sobre medidas de saúde pública durante a pandemia pós-COVID-19 em Bangladesh. Este estudo fornece que a infraestrutura geral, a capacidade de resposta e os vínculos têm uma correlação significativa com a confiança dos jovens, pois todos os valores de p < 0.001. Conclusões: a infraestrutura de saúde e o vínculo dos jovens às várias redes e instituições têm mais impacto na determinação do nível de confiança nas medidas governamentais de saúde durante o pós-pandemia do que na forma de resposta do governo; os formuladores de políticas e defensores obterão uma visão significativa das descobertas do estudo durante o período pós-COVID-19. Sem medidas de política de saúde sensíveis ao gênero, será difícil ganhar a confiança dos cidadãos para o governo.

A Educação Física pós-crítica e suas teleologias: entre a valorização da diferença e o sujeito solidário / Post-critical Physical Education and its teleologies: between the valorization of difference and the subject of solidarity / La Educación Física postcrítica y sus teleologías: entre la valorización de la diferencia y el sujeto solidario

RESUMO O artigo recorreu à hermenêutica filosófica como método analítico para produzir um mapa das teleologias educativas da chamada Educação Física pós-crítica. Os resultados demonstram uma movimentação das proposições teleológicas inicialmente afeitas à noção de emancipação e participação social para vinculação com o reconhecimento e valorização da diferença, culminando nas relações de solidariedade e o estabelecimento de alianças em prol do bem comum. A constatação fez buscar o apoio nas filosofias da diferença para problematizar a noção de subjetividade solidária anunciada pela teoria curricular cultural da Educação Física, conferindo-lhe o necessário, porém provisório, estofo epistemológico.

ABSTRACT The article resorted to philosophical hermeneutics as an analytical method to produce a map of the educational teleologies of the so-called post-critical Physical Education. The results demonstrate a shift from teleological propositions initially linked to the notion of emancipation and social participation towards a link with the recognition and appreciation of difference, culminating in relations of solidarity and the establishment of alliances in favor of the common good. This finding led to the search for support in the philosophies of difference to problematize the notion of solidary subjectivity announced by the cultural curricular theory of Physical Education, giving it the necessary, but provisional, epistemological padding.

RESUMEN El artículo recurrió a la hermenéutica filosófica como método analítico para elaborar un mapa de las teleologías educativas de la llamada Educación Física poscrítica. Los resultados demuestran un giro desde proposiciones teleológicas inicialmente vinculadas a la noción de emancipación y participación social hacia un vínculo con el reconocimiento y valoración de la diferencia, culminando en relaciones de solidaridad y el establecimiento de alianzas a favor del bien común. Este hallazgo llevó a la búsqueda de apoyo en las filosofías de la diferencia para problematizar la noción de subjetividad solidaria anunciada por la teoría cultural curricular de la Educación Física, dándole el necesario, pero provisional, relleno epistemológico.

Entrevista com a professora maura corcini lopes: a produção do ser surdo na experiência da educação / Interview with professor maura corcini lopes: the production of the deaf subject in the experience of education

RESUMO Ao longo da presente entrevista, a Professora Maura Corcini Lopes, da Universidade do Vale do Rio dos Sinos, desenvolve um conjunto de análises relativas à educação de surdos, a partir de uma retomada dos artigos publicados na Revista Brasileira de Educação Especial sobre a educação de surdos, ao longo das três décadas de existência desse periódico. Ela convida o leitor a refletir sobre os tipos de saberes produzidos sobre a surdez e as formas como os sujeitos com surdez foram sendo narrados nesse período. Ao voltar a olhar para os últimos 30 anos de proposição de políticas educacionais no Brasil, a Professora Maura problematiza os efeitos dessas políticas na organização de práticas escolares destinados aos alunos surdos e na forma como a sociedade se relaciona com a diferença, pós-políticas de inclusão.

ABSTRACT Throughout this interview, Professor Maura Corcini Lopes, from the Universidade do Vale do Rio dos Sinos, develops a range of analyzes related to the education of the deaf people, starting from a resumption of the articles published in the Revista Brasileira de Educação Especial on the education of the deaf, throughout the three decades of the existence of this journal. She invites the reader to reflect on the types of knowledge produced about deafness and the ways in which the subjects with deafness were being narrated during this period. When looking back at the last 30 years of proposing education policies in Brazil, Professor Maura problematizes the effects of these policies in the organization of school practices aimed at deaf students and the way in which the society relates to difference, after inclusion policies.

Ovarian hormones influence immune response to liver ischemia-reperfusion

Liver injury occurs after ischemia and reperfusion (IR), as seen in transplant settings. Sex hormones have been implicated in many pathophysiological mechanisms in females and this could lead to liver protection under inflammatory reperfusion conditions where an excessive immune response occurs. Despite such assumptions, this fact needs to be further investigated. To address this, female and male C57BL/6J mice (8-12 weeks old) were studied. Bilateral ovariectomy (OVX) was performed in females to decrease estradiol levels. IR was performed, and after two weeks, all animals underwent a sham control operation or IR with euthanasia at the following time points after reperfusion: 6, 12, 24, and 48 h. IR triggered an inflammatory process in the liver with recruitment of neutrophils into the parenchyma of male mice. The female sham mice were protected against liver IR presenting no alteration of aminotransferase (ALT) levels compared to males. OVX caused loss of protection, increasing hepatic injury as represented by increased ALT levels and myeloperoxidase (MPO) activity. Female sham mice showed increased Akt phosphorylation and activation, while males showed reduced Akt activation. Estradiol pretreatment recovered ALT levels after IR injury, which was associated with decreased liver injury.

Yad'lun, the subject and sexuation / Há-um, o sujeito e a sexuação

RESUMO: O artigo visa demonstrar como o aforismo Há-um, forjado e trabalhado por Jacques Lacan notadamente nos seminários O saber do psicanalista e ...ou pior, entre 1971 e 1972, fundamenta a teoria da sexuação, promovida nessa época. Discutimos como as rupturas epistemológicas implicadas no Um desembocam na escrita da impossibilidade de proporção sexual para o ser falante. O aforismo se desdobra, portanto, em: não há relação do Um com o Ser, do Um com o Outro, do Um com o Outro sexo, isto é, não há relação sexual.

ABSTRACT: The article aims to demonstrate how the aphorism Yad'lun, forged and worked out by Jacques Lacan, notably in the seminars The psychoanalyst's knowledge and …or worse between 1971 and 1972, is the basis for the theory of sexuation promoted, at that time. We discussed how the epistemological ruptures involved in the One lead to the writing of the impossibility of sexual proportion for the speaking being. The aphorism unfolds therefore in: there is no relationship between the One and the Being, the One and the Other, the One and the Other sex, that is, there is no sexual relationship.

Predictive value of Pv-aCO 2/Ca-vO 2 combined blood lactate concentration for primary peritonitis-related septic shock in children / 中华危重病急救医学

Objective:To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO 2/Ca-vO 2) in children with primary peritonitis-related septic shock. Methods:A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups.Results:A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO 2/Ca-vO 2, pediatric sequential organ failure assessment, pediatric risk of mortality Ⅲ in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO 2/Ca-vO 2 were independent risk factors affecting the prognosis of children [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO 2/Ca-vO 2 and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO 2/Ca-vO 2 ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO 2/Ca-vO 2 < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO 2/Ca-vO 2 ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ2 = 7.910, P = 0.017). Conclusion:Pv-aCO 2/Ca-vO 2 combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.

Correlation analysis of learning initiative and on-line teaching effectiveness in medical students—with Physiology teaching as an example / 中华医学教育探索杂志

Objective:To evaluate the effects of learning initiative on teaching effectiveness.Methods:The research subjects were the 2nd year medical students of Tongji Medical College of Huazhong University of Science and Technology. The learning initiative factor was calculated from the data of the attendance registration of the on-line learning of Physiology, and the performance of the on-line test was used as an evaluation indicator of teaching effectiveness. SPSS software was used to perform correlation analysis between the learning initiative factor and teaching effectiveness. Results:We found that learning initiative could significantly affect the teaching effectiveness, with differences among different specialties. There was a positive correlation between learning initiative and teaching effectiveness in clinical and pediatric medicine, while no correlation was observed in preventive medicine and medical imaging.Conclusion:In conclusion, learning initiative can affect teaching effectiveness, and the intensity of this effect shows difference among different specialties.

Analysis on the Cognitive Differences between Doctors and Patients in the Evaluation of Doctor-patient Relationship / 中国医学伦理学

There are cognitive differences between doctors and patients in the evaluation of doctor-patient relationship. Doctors place more emphasis on evaluation from a professional perspective, including the application of professional knowledge and skills, as well as the evaluation of patient treatment outcomes. While patients pay more attention to meeting their health needs, including the quality and effectiveness of medical services, and the experience of communication and care. This cognitive difference is influenced by factors such as culture, social background, education, information acquisition, etc. To alleviate this difference, it is necessary to strengthen doctor-patient communication and negotiation, strengthen doctor-patient education and interaction, and establish a fair and transparent medical system.

Role of androgen receptors in the development of hepatocellular carcinoma / 上海预防医学

Hepatocellular carcinoma （HCC） has emerged as a significant public health concern， posing a serious threat to the lives and health of residents in China. Furthermore， the incidence and mortality rates of HCC are notably higher in males than in females. Androgen receptors （AR） can contribute to the occurrence of male-specific cancers such as prostate cancer， suggesting a potential link to the increased susceptibility of males to HCC. Elucidating the cancer-promoting mechanism of AR and developing specific targeted interventions are effective ways to advance tertiary prevention of HCC and improve patient prognosis. This paper reviews the relevant evidence of AR’s role in promoting the occurrence and development of HCC， summarizes relevant mechanisms discovered to date， including promoting the stemness of HCC cells， altering the immune microenvironment， regulating key signaling pathways， inducing glycolysis in hepatocellular carcinoma， and synergizing with hepatitis B virus to promote HCC. Additionally， research directions for targeted interventions in HCC through AR-related signaling pathways are discussed.

Analysis of the current situation and countermeasures of pediatric drug procurement in China under the background of centralized drug procurement / 中国药房

OBJECTIVE To analyze the current situation of pediatric drug use under centralized drug procurement， and to provide reference for the subsequent design of pediatric drug centralized procurement rules. METHODS The comparative analysis method was used to analyze the problems in the centralized procurement， clinical use and supply of pediatric drugs from the aspects of centralized procurement selection results and actual use of pediatric drugs， price difference and online prices of pediatric drugs. The solutions were put forward to optimize the centralized procurement and pricing rules of pediatric drugs. RESULTS & CONCLUSIONS The demands for pediatric drugs in China were increasing， but the supply of marketed pediatric drugs was insufficient （including insufficient coverage of disease fields， insufficient varieties， insufficient suitable dosage forms for children， insufficient specifications for children， etc.）， and the development of pediatric drugs was relatively difficult. After merging the dosage forms of centralized procurement according to the medical insurance list， some suitable dosage forms and specifications for children couldn’t be selected， resulting in a shortage of clinical pediatric medication. Relevant enterprises’ enthusiasm for developing and producing pediatric drugs and participating in online competitions had decreased. There was also the problem of underpricing of pediatric drugs under the drug price difference ratio rule. It is recommended that when conducting centralized drug procurement， special drugs for children should be grouped separately for centralized procurement based on attributes and the population covered by the indications. The specifications of suitable pediatric drugs that were not selected are converted into the agreed purchase quantity of medical institutions in a certain proportion. It is necessary to further optimize the pricing rules for pediatric specialized drugs， ensure a certain profit margin for such drugs， increase the willingness of production enterprises to research， develop and supply drugs， and thus ensure the use and supply of pediatric drugs.

Difference analysis of imported malaria characteristics in Pudong New Area of Shanghai before and after COVID-19 / 上海预防医学

ObjectiveTo describe the differences in imported malaria cases before and after the COVID-19 pandemic in Pudong New Area， Shanghai， to explore the possible impact of isolation measures during the pandemic on malaria， and to provide a basis for formulation of malaria control strategies during the prevention and control of major infectious diseases in the future. MethodsInformation on malaria cases reported in Pudong New Area from 2017 to 2022 was collected and divided into two groups： cases before the COVID-19 pandemic （2017‒2019） and cases after the COVID-19 pandemic （2020‒2022）. Analysis was conducted on information such as gender， age， parasite species， country of infection， place of onset， time of onset， time of first diagnosis， time of confirmed diagnosis， hospitalization， and duration of treatment for both groups. ResultsThe pre-COVID group consisted of 21 cases， and post-COVID group consisted of 28 cases， with male and falciparum malaria predominating in both groups. There were statistically significant differences between the two groups in terms of Shanghai residency status， use of preventive measures， and adherence to standardized treatment （P<0.05）. The time interval from symptom onset to first diagnosis was longer in the pre-COVID group than that in the post-COVID group （Z=-2.617， P<0.05 ）. The interval from the first diagnosis to the confirmed diagnosis and duration of treatment were shorter in the pre-COVID group than that in the post-COVID group （Z=-3.381， P<0.05； Z=-4.148， P<0.05）. There was no significant difference in gender， age， malaria classification， source of infection， onset area， length of hospital stay， complications， severe cases， and interval between onset and diagnosis between the two groups （P>0.05）. ConclusionAfter the outbreak of COVID-19， the medical priority plan prolongs the treatment time of malaria patients， increasing the risk of severe illness and death.

Application of prone position in severe ARDS caused by pneumocystis jirovecii pneumonia after kidney transplantation / 器官移植

Objective To investigate the improvement of oxygenation after the treatment of prone position in patients with severe acute respiratory distress syndrome (ARDS) caused by pneumocystis jirovecii pneumonia (PJP) after kidney transplantation. Methods Clinical data of 5 cases of moderate and severe ARDS caused by PJP after kidney transplantation were analyzed retrospectively, and clinical characteristics, treatment regimen and prognosis were summarized. Results Clinical manifestations of 5 patients were fever, dry cough, chest tightness, shortness ofbreath,sweating and fatigue, and body temperature fluctuated between 38 ℃ and 39 ℃, percutaneous arterial oxygen saturation(SpO2) was gradually decreased, and respiratory distress symptoms were worsened. Pulmonary CT scan showed diffuse ground-glass shadow. After transfer to intensive care unit (ICU), immunosuppressive drugs were terminated, and all patients were given with compound sulfamethoxazole, caspofungin, low-dose glucocorticoids against pneumocystis jirovecii (PJ), oxygen therapy and other symptomatic supportive treatments. Four patients diagnosed with severe ARDS upon admission to ICU were treated in a prone position. One patient with moderate ARDS was not kept in a prone position. At 1 d after treatment in a prone position, partial pressure of arterial oxygen (PaO2) and oxygenation index were increased, whereas alveolar-arterial oxygen difference (A-aDO2) was decreased compared with before treatment (allP<0.05). Compared with 1 d after treatment, SpO2, PaO2 and oxygenation index were all increased, while A-aDO2 was decreased at 4 d after treatment (all P<0.05). Box diagram showed that oxygenation index showed an overall upward trend after prone-position treatment, whereas A-aDO2 showed an overall downward trend. The length of ICU stay of 5 patients was 14 (8, 29) d. All patients in a prone position did not develop complications, such as skin pressure sore, tube detachment and tube displacement, etc. Among 5 patients, 4 patients were mitigated, and 1 patient died of septic shock and multiple organ failure. Conclusions For both conscious and intubated patients, a prone position may significantly improve oxygenation and prognosis of patients with severe ARDS caused by PJP after kidney transplantation. Early diagnosis and accurate and standardized treatment play a pivotal role in enhancing cure rate.

Risk Perception and Emergency Preparedness Against Flood Affected Participants From the Primary Health Care Centre, Malaysia: A Comparison Between Genders

@#Introduction: Flooding has become a major natural disaster in Malaysia in recent decades. There may be a gender difference in many aspects related to flood response and practice. This study aimed to examine the gender gap in knowledge, attitudes, and practice of flood preparedness in Malaysia. Method: This cross-sectional study was conducted among patients attending the primary care clinic at Universiti Sains Malaysia health campus, Kelantan. A validated questionnaire was used for data collection. Results: 328 subjects were recruited, 56.1% of them were females. The female respondents were younger than the males (36 vs. 41 years old). However, females have better knowledge, and practice on flood preparedness compared to male respondents. Among those, women were more aware of the local emergency plan than males (p=0.01). More female respondents kept their vaccination and personal medical records in a waterproof container or sealed plastic bag during past and future flood preparations (3-5 day supply of non-perishable food) than male respondents (p<0.05). In addition, with the practice of keeping a one-week supply of medication, and having their medical records in a waterproof container along with a first-aid kit (p=0.001). For future flood preparation, more women would filter the cloudy water through clean clothes for boiling (p=0.035). The determinants of good preparedness for future floods for female were older-age (p=0.001), blue-collar (p=0.043); whereas male were lower household income (p=0.014), being blue collar (0.014) and white collar (0.039) compared with student/retiree based on multivariate logistic regression. Conclusion: Our study reported that the determinants of good preparedness for future floods were older-age, blue-collar and having a lower-household income.

Analysis on the implementation effect of single disease payment policy for day surgery based on difference-in-differences model / 中华医院管理杂志

Objective:To analyze the implementation effect of single disease payment policy for day surgery (hereinafter referred to as the policy), for references for the reform of medical insurance payment.Methods:By collecting the information of inpatients from 2017 to 2019 in a tertiary hospital, the research group took patients with colorectal benign tumor and nodular goitre as the policy implementation group and the control group respectively. 2017-2018 was the pre implementation stage of the policy, and 2019 was the post implementation stage of the policy. The difference-in-differences (DID) model was used to analyze the changes in indicators such as length of stay and hospitalization expenses after policy implementation, under whether the policy is implemented or not, as well as before or after policy implementation.Results:A total of 2 419 patients were included, including 927 patients with nodular goiter in the control group and 1 492 patients with colorectal benign tumors in the policy implementation group (688 patients before the policy implementation and 804 patients after the policy implementation). The results of DID showed that the hospital days for patients with colorectal benign tumor decreased by 56.53%, the hospitalization expenses decreased by 26.51%, the out-of-pocket expenses decreased by 26.66%, the treatment expenses increased by 11.96%, the drug expenses decreased by 50.29% and the consumables expenses decreased by 20.23% after the implementation of the policy.Conclusions:The implementation of the policy could reduce length of stay, hospitalization expenses and out-of-pocket expenses, optimize the structure of hospitalization expenses, improve the efficiency of hospital diagnosis and treatment, and help the hospital realize its transformation from a size expansion to a quality and benefit expansion.